Mental Health Providers May Have Biases

Although their attitudes are more positive than those of the general public, a significant number of mental health professionals would be unwilling to live near or work with someone who has an untreated psychiatric disorder, especially schizophrenia, according to a study in the journal Psychiatric Services in Advance.

“How people with mental disorders are viewed by treatment providers and the general public can have a significant impact on treatment outcomes and the quality of life of clients,” writes Dr. Bruce Link, professor of epidemiology and sociomedical sciences at Columbia, and Dr. Jennifer Stuber and colleagues at the University of Washington.

The researchers compared the survey responses of a representative sample of 731 providers of mental health services, including psychiatrists, therapists and psychologists, case managers, psychiatric nurses, program directors, and managers with a general population sample of 770. The mental health providers were recruited by the CEOs of community mental health agencies in Washington State and were representative of gender, race-ethnicity, job title, and education level demographics that mirror the national mental health workforce. The general population sample came from the General Social Survey, an in-person survey that is widely used for its extensive data on Americans’ attitudes about many topics.

Both groups were presented with vignettes that described people with untreated depression and schizophrenia without being told of their diagnosis. The groups were asked how they would respond to these people living next door, working closely on the job, marrying into the family, or living nearby in a group home.

Both providers and the general population had more positive attitudes toward those with depression compared to those with schizophrenia, who they sometimes viewed as potentially violent.

“While conceptions of dangerousness of people with schizophrenia are erroneous at a population level, it is possible the providers have witnessed firsthand examples of violence or other dangerous behavior among untreated, symptomatic patients,” the authors write.

More than one-third of the providers said they would be unwilling to have an individual with schizophrenia as a coworker, and about one-third said this individual was likely to use violence toward others.

Negative perceptions toward disorders that involve psychosis have increased with rising news coverage of mass shootings implicating people with mental illness, according to the authors, even though such illness is almost never the only reason for this violence.

Older, male mental health professionals were more likely to view people in the depression and schizophrenia vignettes as less competent, compared with younger, female professionals. Providers with more advanced degrees held more positive attitudes than those with less education. Program managers held more positive views than other mental health workers.

Among the general population sample, older people and women were more likely to have positive attitudes than younger people and men.

The 32 percent of providers who were most likely to hold positive views were older, had been professionally active for longer, or had been diagnosed with a mental illness.

The authors said there are some limits to the study. One is that they are limited from directly comparing statistics from the two groups because the general population survey was conducted in person, while the provider survey was conducted online. The provider response rate was also relatively low, which potentially creates a bias if the people who did not respond have a “systematically” different view than those who responded.

“People with mental illnesses often ask me whether I have studied stigmatizing responses of mental health providers. They say that the experience of negative attitudes from providers is particularly troublesome to them because it occurs in the place where they go to get help for such problems,” says Dr. Link. “I can now answer that we have done such a study and can use the results to advocate for interventions that might improve attitudes and thereby the treatment experience of people who seek help.”

The study comes a little over a year after the Newtown, Conn., shooting, which raised the issue of using mental health examinations to predict violence in individuals. There are fears, however, that linking violence and mental illness can cause bias against those with psychiatric conditions. In fact, those with mental illness are more likely to be a victim of a crime than to perpetrate one, according to a 2001 study in the Lancet.